Senator Frist, Stem Cell Advocate

Perhaps sensing that he would never win the White House unless he did embryonic stem cells might have returned Terri Schiavo to her former self, Senator Frist has issued an about face on stem cell research. Although the story didn't upstage the confessions of a rap vixen, even in the Washington Post, there is every evidence that this will shake up the vote on stem cells, leaving it to our President to make the veto happen. From the Juvenile Diabetes Research Foundation press release:

As you may have seen on this morning’s news, Senate Majority Leader Bill Frist has announced his support for H.R. 810, a bill that would expand the current federal policy on embryonic stem cell research. Senator Frist now joins the nation’s top scientists and researchers, 80 Nobel Laureates, a majority of the American public, more than 200 top patient advocacy and medical research organizations, and a majority of the United States House of Representatives in supporting legislation to further this research that holds great promise for curing or treating a variety of diseases that currently afflict more than 100 Americans.

In a speech on the Senate floor today, Senator Frist declared his support for embryonic stem cell research by stating:

“While human embryonic stem cell research is still at a very early stage, the limitations put in place in 2001 will, over time, slow our ability to bring potential new treatments for certain diseases. Therefore, I believe the president’s policy should be modified… Cure today may be just a theory, a hope, a dream, but the promise is powerful enough that I believe this research deserves our increased energy and focus. Embryonic stem cell research must be supported. Its time for a modified policy – the right policy for this moment in time.”

H.R. 810, the Stem Cell Research Enhancement Act of 2005, was passed by the House in May, and now has more than 40 cosponsors in the Senate. Its champions in the Senate, led by Arlen Specter (R-PA) and Tom Harkin (D-IA), had been pushing to bring H.R. 810 to the floor, but were not able to reach an agreement on the vote before the August recess that begins this weekend.

The Senate will be out of session through Labor Day, which means that your Senators will be back in their home state attending public events and holding town hall meetings. Please use this opportunity to explain why embryonic stem cell research is important to you, and personally ask your Senators to support H.R. 810 when the Senate returns in September.

Short People Have No Reason to Live

A study of Swedish men found that

Shorter men may be more likely than their taller peers to commit suicide -- suggesting, researchers say, that various factors related to growth and development also affect suicide risk later in life. In a study of records for nearly 1.3 million Swedish men, the investigators found that for every 2 inches a man gained in height, his suicide risk dipped by 9 percent. Overall, the shortest men in the study were about twice as likely as the tallest men to commit suicide.

A few previous studies have uncovered a similar height-suicide relationship among men, with some suggestion that income and social class explain the link; children who grow up disadvantaged may have both poorer growth and a higher suicide rates as adults.

The Complicity of the Media in Drug Marketing

The thesis of this piece in Columbia Journalism Review is that the media is complicit in drug marketing. I would somewhat disagree. I think the media often does not know how to evaluate marketing claims and that is hardly unique to the pharmaceutical industry--think of the coverage of the food industry or of the space program or of claims about medicine's war on cancer and its successes. The media is in the news business a bit of the time and the entertainment business much of the time and the grab your attention in any way we can mode all of the time. No one should think of the media as really capable of getting past its fundamental business values to become a 'fair' broker of health news.
Not gonna happen. - Art Caplan

The Future Looks Grim. Again.

Time's Richard Schickel reviews The Island, the new cloning movie just out.

If we're to believe The Island, the private sector, in the very near future, is about to make Halliburton and the rest of those scary big guys look like a kids' corner lemonade stand. Director Michael Bay's new movie posits a secretive biotech operation offering rich people the opportunity to have their very own, disease-free clones. In other words, for $5 million you can have a more or less living insurance policy. Need a kidney transplant? You got it, helicoptered right to the operating room.

It's a sweet, even vaguely plausible, scheme. The clones are kept in a nice white bunker, their health is closely monitored, all their needs--up to the mental age of 15--are provided for, and sex is not an issue since the system's mastermind, Merrick (Sean Bean), has simply eliminated that messy urge. He feeds them on two myths. One is that they are the only survivors of a vast "contamination" that has wiped out the rest of human life. The other is that there's a paradisical, uncontaminated island on which you can win residence by giving birth or through a lottery that is the clones' major source of entertainment.

What Merrick doesn't count on is the clones developing minds of their own. Well, not exactly minds--more like trace memories borrowed from the people they are doubling for. But you know how it is: you get to remembering, and then you get to thinking. It's sort of the same way with romance. Cute guy (Ewan McGregor) and pretty girl (Scarlett Johansson) start making eyes at each other, escape to the fully populated, slightly dystopian real world and, sure enough, find time amid the car chases and explosions to start fooling around. There are other trace elements in the film: a clone Adam and Eve, a bit of Faust, a touch of George Orwell (McGregor is like 1984's Winston Smith, whose curiosity about unanswered questions got him into such terrible trouble).

But mostly the roots of The Island are to be found in every (presumptive) summer blockbuster you ever saw, especially the futuristic ones--or decided, upon mature reflection, not to see. To give Bay (Armageddon, Pearl Harbor) his due, there's a certain wit and splash (or should we make that splat?) in his action sequences--nice stuff with a flying motorcycle and a surprise-filled sequence in which the leads are hanging onto a skyscraper sign that's losing its moorings. But for all the menace of its techno-prattle, its implicit boosts for humanism and its swell production design, the picture is finally a bore. Sci-fi was more powerful when its special effects were cheap and crude, its ideas simple but potently stated.

[thanks Andrew Rosenthal]

Unduly Induce Us, Please

The Austrian philosopher Ludwig Wittgenstein famously claimed that many traditional philosophical problems are ultimately rooted in conceptual confusions. Once these confusions are carefully exposed and analyzed, he believed, the problems are not just answered: they forfeit their original status as genuine problems, and simply vanish into thin air.

In this week’s Lancet, Ezekiel Emanuel et. al. make a noble attempt to make the problem of undue inducements disappear. Undue inducement is commonly regarded a standard research ethics problem and is viewed as particularly acute in international biomedical research. On the one hand, researchers are instructed not to provide excessively attractive incentives to prospective research participants, because this ‘offer you can hardly refuse’ could undermine the voluntary element of consent. On the other hand, much of international research takes place in impoverished countries where simply having blood pressure taken for free by a medical practitioner could be wildly seductive. Many an international researcher has agonized over how to recruit participants in low-income countries without violating their autonomy in the process.

According to Emanuel et. al., worries over undue inducements in international research are misplaced. Properly understood, undue inducements involve (1) the offer of a highly attractive good where (2) the offer undermines the persons judgment and (3) has them agreeing to take serious risks that threaten his/her fundamental interests. But in fact (3) is doing all the ethical work here. Inducements in research are only unethical according to Emanuel et. al. if they entice the participant to enter a study with a highly unfavorable risk-benefit ratio. Inducement itself, in other words, is not the problem: inducement into unduly risky research is the problem. As long as a research study fulfills basic ethical requirements – including the minimization of risk – then the problem of ‘undue inducement’ vanishes.

The argument seems to have an interesting implication. There appears to be nothing in principle stopping researchers from pulling out all the stops in terms of benefits, for as long as the research study is in ethically good shape, even awesome inducement is not undue inducement. In moderate and low-risk studies, why not just offer research subjects whopping big sums of cash to join?

Given the current state of health research budgets, and the general reluctance to substantially reduce global inequalities, the lavishing of benefits on developing world research participants is unlikely to happen. But it is nice to hear that there is nothing ethically against it.
- Stuart Rennie

Mexico to Map the DNA of its Population

The Mexican Government, IBM, and Applied Biosystems Group will map the genes of all Mexicans. The project's commercial arm is pharmacogenomics: "Besides mapping genes, the Genomic Medicine institute and Applied Biosystems will launch a pilot project looking for genetically based drugs specific to Latin Americans and those of Latin American descent."

This Guy is from Massachusetts?

Massachusetts Governor Mitt Romney, eagerly seeking to give life to a possible run for the White House, has vetoed the morning after pill legislation in Massachusetts. The bill, which makes it much easier to obtain the morning after pill, even in Catholic hospitals and without a prescription at pharmacies around the state, is veto-proof. So it is a symbolic gesture. But what is the symbol? That he is clueless?

The governor said he believed that the pill sometimes functioned as "an abortion pill," not just contraception.

That he lied to get elected?

In 1994, during his failed effort to unseat Senator Edward M. Kennedy, he told The Boston Herald in response to a question: "I think it would be a positive thing to have women have the choice of taking the morning-after pill. I would favor having it available." And during his successful run for governor in 2002, he replied yes when asked on a Planned Parenthood questionnaire, "Do you support efforts to increase access to emergency contraception?"

That he has Rove-esque sensibilities?

He said supporting the legislation would mean breaking a promise he made during the governor's race that while he personally opposed abortion, he would not change the state's abortion laws. At the time, that promise was widely interpreted as an effort to satisfy the majority of Massachusetts' constituents by pledging not to make abortion laws more restrictive. But Mr. Romney said Monday that he would also not change the laws to make them more permissive.

You choose.

Why is Media Coverage of Medicine So Awful?

The complaints are familiar (but accurate) in this article in PLoS Medicine. The real question is what will it take to bring about substantive change in media coverage of health and health care. Nothing on the immediate horizon points toward any reason for optimism given the lesser emphasis on news on the networks and local TV, attacks on public radio, and the continued infotainment push on cable news outlets.
- Art Caplan

Attention Deficit Disorder, Drugs, and Enhancement

The new issue of The American Journal of Bioethics is just out, and the Target Articles include a major exploration of dosing of medication for children with ADHD by Illina Singh, which features open peer commentary essays by, among others, Peter Kramer and Paul Appelbaum. As well there is an exploration of the ethics of enhancement by Francis M. Kamm, Guggenheim fellow and now Littauer Professor of Philosophy at the Kennedy School of Government. Kamm takes on Sandel, and furthers a debate started in AJOB's very first issue by Norman Daniels - where should we go with enhancement technologies? Also in this issue: a review of George Annas' new book American Bioethics by Al Jonsen, a review of Zeke Emanuel, Robert Crouch and John Arras' new book on research ethics, an In Focus article on U.S. military sponsored vaccine trials in Nepal, and a pointed exchange of letters between Jeffrey Kahn, Carl Elliot and James Coyne concerning the latter's article about Carl Elliot and the David Healy affair. Bon appetit.

Us, Only Somewhere Else

Classical Values, a great blog that covers much of politics and is written by someone with tons of investigative instinct, took one of our posts as a jumping off point on stem cell research. His post is a great place to begin in looking into the Senate debate on stem cells this coming week.

Pray for Placebo Control

Prayer's power to heal is examined in a recent study entitled "Mantra II" conducted at Duke by a cardiologist. The experiment involved 748 patients who were treated for heart problems at nine hospitals around the nation. Contrary to several recent and oft-cited studies, in this the largest study of the phenomenon, there was no empirical evidence that prayer by strangers made any difference in outcomes:

The researchers enlisted 12 congregations of various Christian denominations, Jews, Muslims and Buddhists around the world to pray for some of the patients, giving them names, ages and descriptions of the illness. The researchers then divided the patients into four groups. The first quarter had people praying for them. The second quarter received a nontraditional treatment known as music, imagery and touch (MIT) therapy, which involved breathing techniques, soothing music, touch and other ways to relieve stress, such as calming mental images. The third group received both prayer and MIT, while the fourth received nothing.

In the final year of the study, the researchers took the additional step of asking more religious congregations to pray for the prayers of the initial group to work. Neither the patients nor their doctors knew whether someone was praying for them. The prayers varied depending on the religion, lasting between six and 30 days.

The researchers then followed all the patients for six months to see which patients suffered serious complications, were re-hospitalized or died from heart problems. Overall, there was no difference among the four groups, the researchers report in Saturday's issue of the Lancet medical journal.

Drugged Up Celebrities

Endorsements are everything in pharmaceutical marketing, or at least that is the current conventional wisdom. The big endorsements of course would be from famous bioethicists, I know, because I read it in the Lancet. But I guess all of the bioethicists were too expensive, so pharma had to settle for buying celebrities. Tim Murphy found this account of who represents what. The B-list folks are really hawking some pretty sad stuff, too:

Ian Anderson, band member of Jethro Tull, has discussed deep vein thrombosis
for the maker of the blood-thinner Lovenox, from Aventis.
Julie Andrews, singer, has discussed osteoporosis on behalf of the drug Evista, from Eli Lilly. Her mother has condition.
Lauren Bacall, actress and Blackgama icon, has promoted the anti-macular degeneration drug Visudyne, for Novartis. Her friend has the condition.
Angela Bassett, actress, has promoted the anti-cholesterol drug, Pravachol, for Bristol-Myers-Squibb.
Lorraine Bracco, actress, discusses depression for Pfizer, which makes the anti-depressant Zoloft. She has been treated for depression.
Linda Carter, "Wonder Woman," has discussed irritable bowel syndrome for maker of Zellnarm, Novartis. She has the condition.
Mike Ditka, coach, restaurateur, and sometime purveyor of pork chops, has pitched Viagra for Pfizer.
Robert Dole, former Senator and Presidential candidate, has encouraged treatment for impotence in ads paid for Viagra, from Pfizer.
Kirk Douglas, founder of acting dynasty, has promoted the anti-cholesterol drug, Pravachol, for Bristol-Myers-Squibb.
Olympia Dukakis, actress and cousin to presidential candidate, has discussed shingles while promoting Lidocaine for Endo Pharmaceuticals. Her mother had the condition.
Peggy Fleming, Olympic skater, has promoted Lipitor for high cholesterol, for Pfizer. She has the condition.
Kelsey Grammar, actor, has discussed irritable bowel syndrome for maker of Lotronex, GlaxoSmithKline. His wife has the condition.
Dorothy Hamill, Olympic skater, has pitched Merck's Vioxx for use against arthritis.
Bruce Jenner, Olympic athlete, has pitched Merck's Vioxx for use against arthritis.
Magic Johnson, basketball star and entrepreneur, has spoken about AIDS awareness for anti-HIV-drug maker GlaxoKlineSmith. He has had HIV infection since 1990.
Guy Lafleur, hockey player, has pitched Viagra for Pfizer.
Tara Lipinski, Olympic skater, has discussed deep vein thrombosis for Aventis, the maker of the blood-thinner Lovenox.
Rob Lowe, actor and Dukakis supporter, has spoken about infection that occurs during chemotherapy, for Amgen, the maker of Neulasta. His father had this problem.
Alonzo Mourning, has done an ad for the anemia drug Procrit, for Johnson & Johnson. He has used the drug himself.
Jack Nicklaus, golf master, has promoted the blood pressure drug Altace, which he has used.
Rafael Palmiero, baseball star, has pitched Viagra for Pfizer.
Pélé, soccer legend, has pitched Viagra.
Mike Piazza, baseball star, has promoted Claritin. He has used the product. Dan Reeves, football coach, has promoted the anti-cholesterol drug, Zocor, for Merck. He has heart disease.
Debbie Reynolds, irrepressible Broadway actress, has promoted Detrol for Pfizer. She has an overactive bladder (among other things).
Dan Quayle, former Vice President and money-in-the-bank for late-night comics, has discussed deep vein thrombosis for make of Blood-thinner Lovenox, Aventis.
Sylvester Stallone, wealthy actor in spite of everything, has promoted the anti-cholesterol drug, Pravachol, for Bristol-Myers-Squibb.
Kathleen Turner, husky-voiced actress, has discussed rheumatoid arthritis, for maker of Enbrel, Wyeth. She has condition.
Ricky Williams, football player, has promoted Paxil for GlaxoSmithKline. He has used the drug.
Anna Wilson, rock singer, has promoted the Lap-band, for Inamed. She has used the device - which fastens around the abdomen -- following her obesity surgery.

All I know is that I'm not selling out for less than Dan Quayle. It would be unethical.

Children, Witches and Bioethics

Writes Stuart Rennie:

In June this year, three Angolans in London were convicted of abusing an eight-year old orphan Angolan girl by (among other cruelties) beating her with a belt, cutting her with knives, and rubbing chili peppers in her eyes. But it was not just the gruesome details that caught the British public’s attention. It was the motives for the torture: the girl was regarded by her tormentors as a witch. What might seem an obvious case of child abuse was, in the eyes of the perpetrators, a matter of ‘do-it-yourself exorcism’.

The case has drawn attention to the fact that in central African countries plagued by war poverty and state collapse, a significant number of children are regarded as witches. While general beliefs in witchcraft and spiritual possession is not at all uncommon in countries like Angola or the Democratic Republic of Congo , the idea of the child-witch is relatively new and deeply disturbing. Children as young as three years old can be accused of bringing misfortune on households – everything from unemployment to the death of family members – and cast out into the street to fend for themselves. According to Save the Children, 60% of the 30,000 street children in Kinshasa, capital of the Democratic Republic of Congo, are accused of being possessed by evil spirits, capable of casting spells, flying at night, transforming into non-human animals or consuming human flesh. Children infected by AIDS are particularly susceptible to accusations of witchcraft.

The child-witch phenomenon in Central Africa has spawned a veritable industry of self-appointed ‘healers’. Family members who want to rid their child of demonic possession often turn -- with what little money they have -- to traditional African practitioners or evangelical ministers. In either case, the child may be forced to undergo painful exorcisms, in abominable conditions, sometimes lasting days. Some don’t survive the ordeal. What has all this got to do with bioethics? Plenty. Bioethics is not just about the ways North Americans and Europeans come to terms with the ethical implications of their expensive technologies. Those who practice bioethics in central Africa have little choice but to reflect critically on how traditional healing practices and influential local forms of religion impact on health and human rights. The influence of beliefs in witchcraft and satanic possession in these regions is unlikely to diminish soon, but local bioethicists could do a great service by redirecting these energies away from the most vulnerable members of society.

Stuart Rennie is a Research Assistant Professor in bioethics at UNC-Chapel Hill. We missed you; welcome back.

Specter Threatens an End Run To Get Vote on Stem Cell Bill

Writes Rick Weiss in today's Washington Post:

With prospects dimming for a simple Senate vote on a bill to loosen President Bush's restrictions on human embryonic stem cell research, Sen. Arlen Specter (R-Pa.) threatened yesterday to circumvent the political logjam by attaching the wording to the appropriations bill for the Department of Health and Human Services.

"I don't like to put it on an appropriations bill, but we waited long enough," a frustrated Specter told reporters in the Capitol. The strategy, he said, is a "fall-back position which I have avoided up 'til now."

Specter is a lead sponsor of a bill, passed by the House in May, that would allow taxpayer dollars to be used to conduct research on medically promising stem cells derived from embryos that are destined to be discarded by fertility clinics. Such cells are off-limits to federally funded scientists under the policy Bush set in 2001. The bill, which polls indicate has broad support and has been considered sure to pass in the Senate, could trigger a showdown with Bush, who has promised a veto.

Although Senate Majority Leader Bill Frist (R-Tenn.) promised months ago to bring the Senate version to the floor, the field has become muddied by the filing of at least six competing bills that would restrict embryo research in various ways. Senators on both sides of the aisle have been unable to agree on which should be brought to the floor and under what terms.

As chairman of the subcommittee overseeing HHS appropriations, Specter said he was in a position -- in consultation with other senators -- to add the stalled bill as an amendment.

Frist spokeswoman Amy Call suggested the prospects for a vote are not dead. "We keep working for a discrete and clear debate and vote on the House bill and other ideas in this sphere," she wrote in an e-mail.

Misusing the Nazi Analogy

Sixty years ago, Allied forces brought an end to Adolf Hitler’s dream that Germany would rule Europe and dominate the world. The death of Nazi Germany gave birth to a charge that still haunts the scientific community— what might be called ”the Nazi analogy.” In ethical or policy disputes about science and medicine, no argument can bring debate to a more screeching halt then the invocation of the Nazi comparison.

Whether the subject is stem cell research, end-of-life care, the conduct of clinical trials in poor nations, abortion, embryo research, animal experimentation, genetic testing, or human experimentation involving vulnerable populations, references to Nazi policies or practices tumble forth from critics. “If X is done, then we are on the road to Nazi Germany” has become a commonplace claim in contemporary bioethical debates.

Sadly, too often those who draw an analogy between current behavior and what the Nazis did do not know what they are talking about. The Nazi analogy is equivalent to dropping a nuclear bomb in ethical battles about science and medicine. Because its misuse diminishes the horror done by Nazi scientists and doctors to their victims, it is ethically incumbent upon those who invoke the Nazi analogy to understand what they are claiming.

A key component of Nazi thought was to rid Germany and the lands under German control of those deemed economic drains on the state—the mentally ill, alcoholics, the “feeble-minded,” and the demented elderly. They were seen as direct threats to the economic viability of the state, a fear rooted in the bitter economic experience after the First World War. The public health of the nation also had to be protected against threats to its genetic health. These were created when people of “inferior” races intermarried with those of Aryan stock. Threats to genetic health also included, by their very existence, genetic degenerates— Jews and Roma. Theories of race hygiene had gained prominence in mainstream German scientific and medical circles as early as the 1920s.

What is important to keep in mind about these underlying themes that provided the underpinning for Nazi euthanasia and eugenic practices is that they have little to do with contemporary ethical debates about science, medicine, or technology. Take, for instance, the case of Terri Schiavo, a massively brain-damaged patient who was kept alive by means of artificial feeding for more than a decade. When congressmen and religious leaders in the United States commented on her situation during the weeks leading up to her death on 31 March 2005, soon after her feeding tube was removed, they described it as analogous to what the Nazis had done to Jews in concentration camps—a complete misuse of the Nazi analogy. Whatever one thought about the ethical issues raised by the decision to allow the removal of a feeding tube from this woman, the decision had nothing to do with the belief that her continued existence posed a threat to the economic integrity of the United States or that her racial background posed a threat to America’s genetic health. The fight over her fate was about who best could represent her wishes so that her self-determination could be respected—a moral principle not afforded those killed by deliberate starvation in the Nazi euthanasia programs.

Similarly, when critics charge that allowing embryonic stem cell research permits the taking of innocent life to serve the common good, and then compare it to Nazi research in concentration camps, the claims of resemblance are deeply flawed; moreover, they demean the immorality of Nazi practices. Concentration camp prisoners were used in lethal experiments because they were seen as doomed to die anyway, were seen as racial inferiors, and, given the conditions of total war that prevailed, they were considered completely expendable in the service of the national security of the Third Reich.

There are many reasons why a practice or policy in contemporary science or medicine might be judged unethical. But the cavalier use of the Nazi analogy in an attempt to bolster an argument is unethical. Sixty years after the fall of the Third Reich, we owe it to those who suffered and died at the hands of the Nazis to insist that those who invoke the Nazi analogy do so with care.
- Arthur Caplan [an Editorial in the July 22 issue of Science]

High Noon. Frist. Specter. Stem Cells.

On stem cells, Specter's playing for keeps , writes Margaret Carlson in the LA Times. Specter is not going to lose this battle. Writes Carlson:

... Specter, who has been battling Hodgkin's disease since February, is his own draw now. Never weaker physically, never stronger mentally, Specter says he is propelled out of bed each day by his work and by the hundreds of letters he has received from patients determined to see stem cell research expanded. His former chief of staff, David Urban, calls him the Lance Armstrong of the Senate: "If you close your eyes and don't look at his bald head and gaunt cheeks, but just listen to him, you'd think he was a well man at the height of his powers."

And Senator Bill is hurting:

Frist enters this fight weakened by his own mistakes. Stung by a string of miscalculations and transparent panderings that haven't paid off, he's made some senators wax nostalgic for the good old days under Trent Lott, who at least wasn't distracted by dreams of being president.

Earlier this year, Frist was unilaterally disarmed by Sen. John McCain (R-Ariz.), who stole seven Republicans to form the Gang of 14, taking Frist's "nuclear option" on filibusters off the table for the time being. Then Frist couldn't get a vote on the floor on John Bolton's nomination as ambassador to the United Nations. In another gaffe, Frist went on "Good Morning America" to claim he hadn't diagnosed Terri Schiavo by videotape. Problem with that was there was a videotape showing him doing just that.

Wanted, Donor Eggs, Cheap; Young Women Preferred

It's right to pay women who give their eggs for research, writes Ronald Green, chair of the ethics advisory board for the stem cell company that is recruiting the largest pool of potential egg donors for stem cell research. He's on the right track, frankly, in that egg donation for research isn't fundamentally different from egg donation for reproduction, and that if it is ok to pay women to donate eggs for reproduction, then it is ok to pay them to donate for research.

But it isn't right to pay them for reproductive donation. In reproductive donation of eggs, the kiddos from colleges are offered preposterous amounts of money for their egg donation, and it has long been suggested that exploitative payments encourage donors who have high credit card debt, etc. Big problem. In egg donation for stem cell research, by contrast, the fee will be smaller. But it will still be priced high enough to attract the very young women whose eggs are best suited (it turns out, as we blogged) to produce stem cells. The payment is not for out of pocket expenses - at which point one would really know that these women are risking their fertility and even their lives for the cause. No, this is just buying eggs cheap. The women are every bit as coerced - in fact perhaps more so.

The big issue in egg donation is that it has to be truly consensual, not bribed.
[disclosure: Dr. McGee was Chair of the Advanced Cell Technology ethics advisory board until 2000]

Fewer Abortions

The Guttmacher Institute reports today that "for every 1,000 pregnancies that did not result in miscarriage in 2002, there were 242 abortions. This figure was 245 in 2000 and 280 in 1990." In other words, "in the year 2002, about 1.29 million women in the U.S. had abortions. In 1990, that number was 1.61 million." Washington Post summarizes other parts of the report:

Women with unintended pregnancies are those most likely to get abortions. According to the Guttmacher report, 47 percent of unintended pregnancies are aborted. Teenagers, unmarried women, black and Hispanic women, and those with low incomes are more likely than the population as a whole to have unintended pregnancies. The report shows that non-Hispanic white women get about 40 percent of all U.S. abortions, black women 32 percent and Hispanic women, who can be of any race, 20 percent. Women of other races account for the other 8 percent. Black and Hispanic women have higher rates of abortion than non-Hispanic whites, the report states. Other facts about U.S. abortions from the Guttmacher report:

· Six in 10 women who had abortions in 2002 were mothers. "Despite the common belief, women who have abortions and those who have children are not two separate groups," said Finer.

· The incidence of abortion spans the economic spectrum, but low-income women are overrepresented among those having the procedure. Sixty percent of women who had abortions in 2000 had incomes of less than twice the poverty level --below $28,000 per year for a family of three, for example. This is in part because "low-income women have lower access to family planning services" such as contraception and counseling provided by health departments, independent clinics or Planned Parenthood, Finer said.

· The majority -- 56 percent -- of women who terminate their pregnancies are in their twenties. Teenagers between 15 and 19 make up 19 percent of abortions, although this percentage has dropped substantially in recent years.

This drop may be due to use of longer-acting hormonal contraceptives and lower rates of sexual activity, said Joyce Abma, a social scientist at the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC).

She added that there has been a decline in sexual activity reported by teenage males, which could be a contributing factor to lower pregnancy and abortion rates among teens.

One More Time, this Time with More Berg and Goldstein: The Stem Cell Alternatives are Baloney

From today's Post:

by Paul Berg, George Q. Daley and Lawrence S.B. Goldstein
Given the general agreement that such research has the potential to relieve the misery and suffering of millions, we find it troubling that opponents of this legislation (H.R. 810 or S. 471) are trying to divert the debate about the merits of expanding this research by promoting dubious approaches to obtaining stem cells that even their supporters concede are scientifically and ethically problematic. What is so bizarre about this effort is that there is no need for the administration and its congr essional followers to seek authorization to pursue these proposed "new" approaches for obtaining stem cells. Research on these proposed alternatives is already legal and can be funded by existing mechanisms.

We want to be very clear: The most successful demonstrated method for creating the most versatile type of stem cells capable of becoming many types of mature human cells is to derive them from human embryos -- at present, excess embryos created at in vitro fertilization clinics and freely donated for research by couples who choose not to have them destroyed as medical waste.

While some of the proposed alternatives being suggested may have some promise, they are unproven. Some, in fact, are ethically questionable when performed with human tissues. One idea is to derive stem cells from embryos that have stopped developing and are thought to be "biologically dead." Beyond the fact that scientists haven't developed a reliable method for determining an embryo's "death," there is no scientific evidence that stem cells derived from these embryos would have the required properties or be safe for human therapies.

Another set of proposals focuses on attempts to reprogram adult cells to revert to an early, undifferentiated, stem cell-like stage of development. This is an important, though highly speculative and ambitious, goal. Indeed, it is a goal that developmental scientists are already seriously investigating today, but with many uncertainties about whether and how it can be made practical. Still another proposal is to separate a single cell from a live embryo while attempting to preserve the embryo's potential to initiate a pregnancy and normal birth. This proposal is not only speculative but poses ethical concerns as to possible damage that might be inflicted on the embryo.

In a July 12 op-ed in The Post, Leon R. Kass, chairman of the President's Council on Bioethics, wrote: "It may be that some opponents of embryo research are using the se worthy proposals for . . . a political purpose." We agree: It is likely that some opponents are pursuing a political purpose in their public embrace of these proposals. We also agree that federal funding for these and many other proposed options, including adult stem cell research, should continue to be provided. ... We urge Congress to deal with this matter on its scientific merits without raising a laundry list of other speculative scientific approaches that serve only to confuse the issue. The treatment of otherwise intractable diseases can become a reality if we expand the number and quality of the stem cells that American scientists have to work with.

Why Can't Scientists be Cooler

This week's The Scientist reminds the reader just how few people love scientists. Not many are viewed like rock stars, writes Richard Gallagher, scientist and editor of The Scientist. In fact, more than he knows, scientists (like intellectuals more generally in the past 20 years) have been almost uniformly demonized by in popular culture in the West. Gallagher imagines a day in which scientists will be much more beloved by the public, even viewed as heroic.

A recent poll of the Top 100 Americans1 included just four scientists, Einstein, Sagan, Salk, and Tesla (although this could be increased to seven if we include Edison, Bell, and Franklin). A similar BBC project2 yielded a healthier 12 scientist in the list of "100 Great British Heroes." Before you get too excited, however, what was striking about that is that only one – Stephen Hawking – is alive. It seems that scientists can be memorable, but only one of us is. To hammer home that point, in another poll teenagers in the UK floundered when asked to name a single contemporary scientist, producing suggestions such as Madonna, Chemical Ali, and their science teacher.3 And in the same poll, only 7% considered scientists to be "cool or fun."

Eric Lander in wrap-around shades and a black trench coat isn't going to carry the same punch as Bono, and I don't see Tony Blair cuddling up to Craig Venter on MTV like he did with Bob Geldof. But we don't want or need to have the impact of the rock fraternity on world opinion. We just need researchers to have a higher profile than the current, pitiful, low.

UPDATE: A READER WRITES: ... caught the latest blog and saw a picture of Tori Higgenson as Dr. Weir posted with the blog on The Scientist's commentary on why scientists can't be cooler ... Why not mention using Dr. Weir/Stargate, and the potential positive connotations scifi television can bring to scientists, since you did use the show/character, and thus roundaboutedly implying just that. (I'll be teaching a class next year using Stargate SG-1 to illustrate ethical principles from Greek time to present, so admit I'm rather biased and keyed to pick up on seeing the show mentioned outside the geek-blog forums.) [Thanks for mentioning it and why not beam up a copy of that syllabus to syllabi@bioethics.org?]

Ties to Industry Among NIH Scientists

A review by the NIH of its own researchers finds that more than 40 government scientists have violated the ethics rules in the institution. There isn't much news here but it made for good press for science foe Joe Barton of Texas.
[thanks Darby Penney]

The Awful Truth about Drugs in Sports

Brian Alexander has done a superb job outlining the key issues and challenges facing doping or 'juicing' in sports. - Art Caplan

Center for Practical Bioethics gets $3M gift

Kansas City Business Journal notes the latest feather in the cap of Myra Christopher, leader of the productive and innovative Center for Practical Bioethics in Kansas City: The Francis Family Foundation has awarded the center $3 million, more than enough to hire an endowed chair, and to move ahead on one of the impressive initiatives that distinguishes that Center as the leader in literally working on policy issues in conjunction with community, clinicians and leaders.

And Speaking of the Deep South

The extremist flat earth society Bioethics Defense Fund, a front for anti-choice folks ("advocates for human rights from beginning to end"), is attacking Louisiana's two research universities, Tulane and LSU, to prevent them from launching any sort of stem cell research involving embryos or SCNT-derived embryo-like things. It is a sophisticated debate, and those who oppose this research (which appears not only not to exist but not even to be in the planning stages at either school) are awfully careful to avoid scandalizing the other side:

A 14 foot by 48 foot billboard, paid for by Tulane and LSU alumnae concerned about the direction of their alma maters, looms above the I-10 eastbound toward the Superdome and the LSU-Tulane medical parkway. The billboard asks the question, "Are Tulane and LSU Planning on Cloning Human Embryos?," and directs viewers to learn more about the Universities' legislative committee testimony and activities at http://www.CuresNotClones.org.

The aim is to bring out the same folks who desperately fear gay marriage, book burning fruitcakes, and ask them to direct some of that passion against those dern eggheads.

All I know is that Dr. John and Professor Longhair would have supported stem cell research. There won't be many protesters who come from the Quarter.

Delivering While Intoxicated

Alta Charo pointed us to an AP story in Oklahoma, where stuff like this actually happens:

BARTLESVILLE, Okla. (AP) -- A woman has been arrested on child neglect charges after giving birth while drunk, police said. Melissa Irene Tanner, 37, is accused of having a blood alcohol content close to three times the legal limit when she gave birth to a baby girl on June 30.

She is being held in jail with bail set at $30,000 and the baby has been placed in foster care. The baby was not breathing upon birth and had to be administered a medication to counteract any narcotics that may have been present in the child's system. After an emergency procedure by hospital staff, the child started breathing.

Tanner reportedly has six other children. According to a July 11 probable cause affidavit filed in the case, Tanner told police she and another person had consumed a case of beer.

Want to Work in Bioethics' Grand Central?

The executive managing editor of The American Journal of Bioethics is leaving us to do lawyer stuff (no, she's not suing us, she actually is a lawyer, and is going to be working in a hospital general counsel office, actually doing something rather than playing academic like the rest of us). So if you love bioethics and want to be engaged in the craziness that comes along with working on a print journal that also controls a website, a blog and umpteen other funded and unfunded projects - alongside 150 writers a year, a 50 member editorial board and zillions of readers - and if you always dreamed of living Upstate, maybe this is your moment. But it really is only a moment - we must hire within the next 30 days:

Alden March Bioethics Institute
Title: Executive Managing Editor, The American Journal of Bioethics
Responsibility: Responsible for Operations of AJOB
Description: the Alden March Bioethics Institute at the Albany Medical College of Union University announces an immediate opening for Executive Managing Editor of The American Journal of Bioethics (AJOB). Start Date: no later than August 22, 2005. The American Journal of Bioethics is the most cited and most widely circulating peer-reviewed journal of bioethics, published in paper and online format by the world's largest science publisher, Taylor & Francis Group. The Executive Managing Editor is involved in all aspects of the editorial and publishing process, but does not have responsibility for sales or customer service. Bachelors degree required. The ideal candidate will be an aspiring scholar or librarian of bioethics. Alden March Bioethics Institute offers the M.S.Bioethics as well as a doctoral program in bioethics and numerous combined degree possibilities (JD/MSB, MPH/MSB, MSW/MSB, MD/MSB), and the position could include tuition remission for graduate study as well as the opportunity for teaching, participation in the AMBI clinical and benchside ethics consultation services, and/or participation in one of the Institute's research programs. Salary to be determined based on qualifications but based on a 25-hour work week. CV and one letter of reference (by email acceptable), or nominations, to Prof. Glenn McGee, Director, Alden March Bioethics Institute, the Albany Medical College of Union University, 47 New Scotland Avenue MC153, Albany NY 12208. Direct questions to Jamie Salm, search coordinator at 518.262.6082.

William Saletan on the Forced Marriage of Stem Cell Opponents

Saletan pens "You're Having My Baby - The forced marriage of stem-cell opponents" in today's Slate, in which he does some clever juxtaposition of the folks who testified to the Senate on the madness of "alternate sources" for embryonic stem cells. The whole debate seems like something out of 1984 - full of double talk and acting and a ballet of appearance and reality. It is mild compared to the Schiavo case, but nutty nonetheless, as we've opined again and again and again here. Saletan does a nice job painting the hearings:

Tuesday morning, I drive past the White House on my way to a stem-cell hearing on Capitol Hill. It feels like one of those basketball playoff series that go back and forth from one city to the other. A month and a half ago, proponents of embryonic stem cell research—for simplicity's sake, I'll call them the pros—pushed a research funding bill through the House, establishing their supremacy in Congress. Then the series moved to the White House, where the antis scored a victory as President Bush pledged to veto the bill.

Now the series moves back to Congress. The pros have orchestrated this hearing. All the senators present are on their side, as are three of the four advocates scheduled to testify. The lone anti witness, Stanford biologist Bill Hurlbut, serves on Bush's bioethics council but opens his remarks by quoting President Clinton's. That's what you have to do in the other team's building.

But it turns out that the pros aren't in control of this game. In fact, it isn't a game, and this is no longer a series. It has become a dialogue, born of each team's failure to eliminate the other. The pros, by winning a referendum in California last fall and passing the House bill, have forced the antis to propose alternative, non-lethal ways of getting embryonic stem cells. The antis, by offering four such ideas in a report from Bush's bioethics council, have forced the pros to apply their scientific ingenuity to those ideas. The ethics and the science are all mixed up. It's beautiful.

Quebec Man Faces Jail Possibility After His Ailing Wife Dies

The Globe and Mail reports that he had left his job as a homecare orderly to look after his ailing wife. Now she is dead and he could go to jail. In the latest case to fuel the ethical debate over mercy killing and assisted suicide, a the man is expected to be charged with the slaying of his wife, who suffered from Friedreich ataxia, a degenerative disorder of the nervous system. Andre Bergeron, 46, had originally been charged with attempted murder after his wife, Marielle Houle, had been rushed to hospital in a coma Thursday. - Art Caplan

The Yammer Begins: Senate Appropriations Subcommittee on Labor Health etc. Takes Up the "Alternative Sources of Stem Cells" Nonsense

George Daley testified this morning and hit the ball out of the part. This is longish, but deserves presentation since you wouldn't see it anywhere else without searching the web like an MIT brat. Daley, who wrote the "Missed opportunities in stem cell research" piece in New England Journal last year, testifies:

Senator Specter, members of the Committee, thank you for inviting me to testify before you. My name is George Daley. I am here today representing the American Society for Cell Biology, a professional society of nearly 12,000 basic biomedical researchers in the United States and 50 nations around the world. I am Associate Professor of Pediatrics and Biological Chemistry at Boston Children’s Hospital and Harvard Medical School, the Associate Director of the Stem Cell Program at Children’s Hospital, a member of the Executive Committee of the Harvard Stem Cell Institute, and Board Member and President-elect of the International Society for Stem Cell Research (term to begin June 2007). My research is focused on using embryonic stem cells and adult stem cells to study blood development, and to develop new treatments for leukemia, and genetic diseases like immune deficiency, sickle cell anemia, thalassemia, and Fanconi’s anemia. I am also clinically active as a hematologist at Children’s Hospital, where I see first-hand the pain and suffering inflicted by these diseases on children and their families. My career is dedicated to making a difference in their lives through research and patient care.

I am here today to state my strong support for Senate passage of HR 810, which has already passed the House of Representatives by an impressive and bipartisan margin. HR 810 would ensure that scientists can use Federal grant funds to study the wide range of valuable human embryonic stem cell lines that have been created since August 9, 2001, the date that President Bush announced his restrictive stem cell research policy. HR 810 would expand research opportunities and accelerate progress towards newer and better therapies for the many children I currently cannot treat successfully.

I am also here to give scientific perspective on the several additional strategies proposed for deriving human pluripotent stem cells that have been considered recently by the President’s Council on Bioethics, and which are the subject of this hearing today. I want to state at the outset that I support efforts to derive pluripotent stem cells by methods that would be ethically acceptable to all, but I do not support delaying the pursuit of medical research on existing human embryonic stem cell lines while these more speculative methods are tested. I believe that Senate passage of HR 810 is the surest means of supporting stem cell research at this juncture.

First let me emphasize why research on human embryonic stem cells is so vitally important, and why alternative forms of adult stem cell research cannot substitute for the study of embryonic stem cells.

Critics of embryonic stem cell research are fond of saying that adult stem cells have been used to cure dozens of diseases while embryonic stem cells have helped no one. I would like to examine that claim. In essentially all cases adult stem cell therapy really means transplantation of blood stem cells to treat leukemia, lymphoma, and various genetic diseases of the blood. Although bone marrow transplants have saved many lives, bone marrow transplant is never a certain cure. Even after many decades of clinical experience, bone marrow transplant remains an aggressive and toxic therapy that carries the highest mortality rate of any medical procedure that is routinely performed. For patients whose only bone marrow match is from unrelated donors outside the family, the treatment itself claims the lives of ~30% of patients in the first year. Indeed, I have cared for many patients who have died during treatment. All of us working in hematology today agree that additional research is needed.

My laboratory is studying embryonic stem cells in hopes of making blood stem cell transplants safer and more widely applicable. A critical part of the strategy is using somatic cell nuclear transfer to generate stem cells that are customized to the specific patients I mentioned earlier, kids with leukemia, immune deficiency, and sickle cell anemia. We hope to correct the genetic defects in these patient-specific cells, direct their differentiation into blood, and transplant kids with these genetically matched autologous cells. This strategy is already working in mice, and we are eager to translate this work into humans. The current Federal funding policies have held us back.

Although it is true that no one has to date been treated with cellular therapies based on human embryonic stem cells, I can assure you that mouse embryonic stem cells have had a major impact on medical research. Over the past 25 years, mouse embryonic stem cells have been used to create models for scores of human diseases, including cancer, heart disease, obesity, and Alzheimer’s. Research discoveries based on these models has led to new drug development and therefore touched countless lives. As for the criticism that no one has been cured with embryonic stem cells, the field of human embryonic stem cell research is a mere 7 years old, so it is premature to expect successful cell therapies to have already been delivered to patients. I believe it is only a matter of time before human embryonic stem cells are used in drug development research and become the basis for important new cell therapies.

As further evidence of how human embryonic stem cells enable unique opportunities to study disease, consider research on Fanconi’s anemia. Kids with Fanconi’s anemia suffer bone marrow failure, and often develop leukemia. Scientists have tried to model this disease in mice, but the mice do not develop bone marrow failure, and the adult blood stem cells from Fanconi’s patients cannot be maintained in culture. Recently, a team from the Reproductive Genetics Institute of Chicago isolated a human embryonic stem cell line that carries a Fanconi’s gene mutation. This cell line could enable us to study the uniquely human aspects of Fanconi’s anemia. However, because of the current Presidential policy, we cannot study these cells with our Feder